Unit 2: CNS Drugs

Indications for Benzodiazepines - Benzos o For sleep disorders and anxiety o Minor tranquilizers and anxiolytics that help with anxiety o These meds can also help with panic disorders o Also used for pre-op sedation - Drug Prototype o Midazolam o Alprazolam - Mechanism of Action o Work by inhibiting GABA neurotransmitters. o Causes CNS depression o Enhancing this causes more CNS repression o Neuron excitability is reduced - BENZOS ALWAYS END IN -PAM AND -LAM - Side Effects o Lethargy o Drowsiness o Dizziness o Blurred Vision o Headache - Adverse Effect o Hypotension o Depression o Dependence/tolerance o Hepatic failure - Contraindications o Respiratory depression o Allergy - Interactions o Other CNS Depressants o Alcohol - Cautions o Older adults o Depression, SI o Severe liver/kidney problems - Indications o Treat insomnia/sleep issues o Considered a sedative/hypnotic o Used as adjuncts for anesthesia; for preop/conscious sedation Nonbenzodiazepines - Mechanism of action for nonbenzos o Ex. Zolpidem  Non benzos work the same with GABA inhibitory neurotransmitters causing CNS depression, but are chemically different than benzodiazepines - SE’s o Dizziness o Drowsiness o Residual sedation o Headache o Blurred vision - Adverse Reactions o Hypotension o Tolerance o Psychological/physical dependence - Contraindications o Allergy to benzos o Respiratory depression o Give cautiously to:  Patients with renal/liver dysfunction  Children, older adults - Interactions o Other CNS depressants o Alcohol o Food decreases absorption - Nursing Assessment o Determine whether the patient has a history of insomnia or anxiety disorders. o Review drug history, medical history (especially addiction) o Assess mental status/vitals - Nursing Interventions o Monitor vital signs o Teach patient how to use nonpharmacologic methods to induce sleep o Observe the patient for adverse reactions (especially respiratory depression, or thoughts of suicide o These meds need to be gradually withdrawn  Can develop a tolerance  Need to taper off slowly - Patient Evaluation o Is the medication helping? o Are there any side effects? o Are they achieving goals of feeling rested with enough sleep? o For depression, assess the patient’s mood o Patient safety is extremely important with benzo and nonbenzos  Before the patient knows how they will react to these meds,  They should only take at bedtime  Not drive or operate heavy machinery  Take at night before a day that is not too busy  Extra care for elderly patient’s s/a bed alarms will help prevent falls - Summary o Benzo and nonbenzos are used to treat insomnia and sleep issues. o This med is considered a sedative/hypnotic o They are sometimes used as adjuncts for anesthesia, for preop sedation or for conscious sedation o Patient safety is critical with these patients, especially in the elderly